Water fluoridation to prevent dental caries

27 Apr 2010

Question No:  386  


Name of the Person: Mr Seah Kian Peng

To ask the Minister for Health (a) whether putting fluoride in our drinking supply is still necessary to prevent dental caries; (b) what is the current percentage of developed countries that still fluoridate their water supply; and (c) what is the empirical experience in Singapore on the levels of dental caries and dental flourosis.


Reply From MOH

We started putting fluoride into our water supply in 1954. Our experts in the Fluoride Review Committee have recommended that we should continue to do so.

First, it has been effective in reducing dental caries. Our dental caries rate has continued to drop in the past decades. One measure of our dental health is the DMFT index: Decayed, Missing and Filled Teeth Index. The DMFT Index for our 12-year old children has fallen progressively from 2.97 in 1970 to 0.54 in 2003. At 0.54, our DMFT Index for 12 year olds is among the lowest in the world. There is also a similar trend among the 15 year olds, where the DMFT Index has fallen from 4.51 in 1970 to 1.00 in 2003. Countries like Finland and Norway, which do not fluoridate their water supply, have reported higher DMFT indices than ours.

Second, research by WHO has shown that fluoride is most effective in preventing dental caries if a low level of fluoride is constantly present in the mouth. While Singaporeans today have access to more sources of fluoride such as fluoride toothpastes and mouth rinses, these products are not used by everyone. Water fluoridation remains the most cost effective preventive public health measure for tooth decay.

Third, the Cochrane Collaboration Oral Health Group, an international expert group, has studied allegations of health risk due to water fluoridation. They found no evidence of such an allegation, so long as the water fluoridation is kept within a certain fluoride concentration level. The latest WHO guideline prescribes it at 1.5 mg per litre. In Singapore, we have over the years progressively reduced our fluoridation level to its current concentration level of 0.6mg per litre in our tap water. This is well within the WHO’s prescribed safety level.

Some 40 countries, including the U.S., Australia, New Zealand and Ireland have water fluoridation schemes in place. Our Fluoride Review Committee meets regularly to review the appropriate and safe concentration level of fluoride in our drinking water. Their conclusion was that dental fluorosis is not prevalent in Singapore, and is only of minor aesthetic concern. Dental fluorosis occurs when a child receives too much fluoride during tooth development. The most common form of dental fluorosis appears as tiny white streaks or specks on the teeth which are often unnoticeable.

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